To test the hypothesis that routine coronary artery bypass surgery (CABG) is not required inpatients undergoing aortic valve replacement (AVR) who have coexistent coronary artery disease (CAD), 51 patients with CAD underwent AVR without CABG since 1972. Another 145 patients without CAD underwent AVR during the same period. In patients with CAD, operative mortality (4%) and late mortality (22% at 3 years) were not significantly different from those without CAD. Moreover, only 14% of patients with CAD had myocardial infarctions during postoperative follow up, (avg., 3.0 years) and 8% subsequently required CABG because of angina. These data suggest that preoperative detection of CAD does not warrant routine CABG in all patients at the time of AVR.